Healthcare Provider Details

I. General information

NPI: 1942673108
Provider Name (Legal Business Name): ANGELICA MIREYA SALAS RESGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 ARCADIA CT
SALINAS CA
93906-5415
US

IV. Provider business mailing address

1941 ARCADIA CT
SALINAS CA
93906-5415
US

V. Phone/Fax

Practice location:
  • Phone: 831-710-0284
  • Fax:
Mailing address:
  • Phone: 831-710-0284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number745540
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: